Minimally invasive direct coronary bypass surgery in a patient after kidney transplantation

Patients with chronic renal failure have a higher risk of coronary heart disease than those with normal renal function. This category of patients is also more likely to have major cardiac and cerebrovascular events (MACCE), which are the main cause of death. Myocardial revascularization in patients with CKD and multivessel coronary artery disease provides better survival rates in comparison with a drug treatment. A clinical case is presented with a successful minimal invasive direct coronary artery bypass (MIDCAB) performed 5 years after kidney transplantation. A 56 years old patient underwent performed allotransplantation of cadaveric kidney on 23.04.2013. Selection according the body system ABO (identical), negative cross-sample, HLA-1 (no matches). The duration of cold ischemia was 5 hours. The graft function was primary normalized on the 26th day after surgery as revealed from the blood creatinine level. Between the years 2013 and 2018, the renal graft function was moderately reduced, although remained stable with minimal urinary syndrome. A maintenance immunosuppression was carried out with tacrolimus (in extended-release formulation capsules), metilprednisolone and azathioprine. During the last 2 years, the patient noted increased shortness of breath and chest pain at minimal physical activity. Cardiocoronarography performed in 2018 revealed an occlusion of the middle segment of left anterior descending artery (LAD), stenosis of the first diagonal branch of permanent residence less than 50%. On 15.5.2018 the MIDCAB of LAD was performed. The left internal thoracic artery was anastomosed with LAD, distal to the second DA. The postoperative period was uneventful. The time spent in ICU was 20 hours. The patient was discharged in a satisfactory condition in 7 days. Eight months after surgery the renal graft function was stable, moderately reduced. The number of published reports of successful coronary bypass surgery (even after off-pump surgery) in patients after kidney transplantation is limited.

трансплантация почки, маммарокоронарное шунтирование из миниторакотомии "на работающем сердце", renal transplant recipient, minimally invasive direct coronary artery bypass

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